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Tiwari P, Yadav A, Kaushik M, Dada R. Cancer risk and male Infertility: Unravelling predictive biomarkers and prognostic indicators. Clin Chim Acta 2024; 558:119670. [PMID: 38614420 DOI: 10.1016/j.cca.2024.119670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
In recent years, there has been a global increase in cases of male infertility. There are about 30 million cases of male infertility worldwide and male reproductive health is showing rapid decline in last few decades. It is now recognized as a potential risk factor for developing certain types of cancer, particularly genitourinary malignancies like testicular and prostate cancer. Male infertility is considered a potential indicator of overall health and an early biomarker for cancer. Cases of unexplained male factor infertility have high levels of oxidative stress and oxidative DNA damage and this induces both denovo germ line mutations and epimutations due to build up of 8-hydroxy 2 deoxygunaosine abase which is highly mutagenic and also induces hypomethylation and genomic instability. Consequently, there is growing evidence to explore the various factors contributing to an increased cancer risk. Currently, the available prognostic and predictive biomarkers associated with semen characteristics and cancer risk are limited but gaining significant attention in clinical research for the diagnosis and treatment of elevated cancer risk in the individual and in offspring. The male germ cell being transcriptionally and translationally inert has a highly truncated repair mechanism and has minimal antioxidants and thus most vulnerable to oxidative injury due to environmental factors and unhealthy lifestyle and social habits. Therefore, advancing our understanding requires a thorough evaluation of the pathophysiologic mechanisms at the DNA, RNA, protein, and metabolite levels to identify key biomarkers that may underlie the pathogenesis of male infertility and associated cancer. Advanced methodologies such as genomics, epigenetics, proteomics, transcriptomics, and metabolomics stand at the forefront of cutting-edge approaches for discovering novel biomarkers, spanning from infertility to associated cancer types. Henceforth, in this review, we aim to assess the role and potential of recently identified predictive and prognostic biomarkers, offering insights into the success of assisted reproductive technologies, causes of azoospermia and idiopathic infertility, the impact of integrated holistic approach and lifestyle modifications, and the monitoring of cancer susceptibility, initiation and progression. Comprehending these biomarkers is crucial for providing comprehensive counselling to infertile men and cancer patients, along with their families.
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Affiliation(s)
- Prabhakar Tiwari
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Anjali Yadav
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Meenakshi Kaushik
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Rima Dada
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Sonigo C, Robin G, Boitrelle F, Fraison E, Sermondade N, Mathieu d'Argent E, Bouet PE, Dupont C, Creux H, Peigné M, Pirrello O, Trombert S, Lecorche E, Dion L, Rocher L, Arama E, Bernard V, Monnet M, Miquel L, Birsal E, Haïm-Boukobza S, Plotton I, Ravel C, Grzegorczyk-Martin V, Huyghe É, Dupuis HGA, Lefebvre T, Leperlier F, Bardet L, Lalami I, Robin C, Simon V, Dijols L, Riss J, Koch A, Bailly C, Rio C, Lebret M, Jegaden M, Fernandez H, Pouly JL, Torre A, Belaisch-Allart J, Antoine JM, Courbiere B. [First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:305-335. [PMID: 38311310 DOI: 10.1016/j.gofs.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Geoffroy Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Florence Boitrelle
- Service de biologie de la reproduction, préservation de fertilité, CECOS, CHI de Poissy, Poissy, France; INRAe, ENVA, BREED, UVSQ, université Paris Saclay, Jouy-en Josas, France
| | - Eloïse Fraison
- Département médecine de la reproduction, CHU Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Charlotte Dupont
- Service de biologie de la reproduction - CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75012 Paris, France
| | - Hélène Creux
- Centre AMP, polyclinique Saint-Roch, 550, avenue du Colonel-André-Pavelet, 34070 Montpellier cedex, France
| | - Maeliss Peigné
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier-Béclère, avenue du 14-Juillet, Bondy, France
| | - Olivier Pirrello
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Sabine Trombert
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Emmanuel Lecorche
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Ludivine Dion
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Laurence Rocher
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Emmanuel Arama
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU Pellegrin, Bordeaux, France
| | - Margaux Monnet
- Département de gynécologie médicale, maternité régionale de Nancy, hôpitaux universitaires de Nancy, Nancy, France
| | - Laura Miquel
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Eva Birsal
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | | | - Ingrid Plotton
- Service d'hormonologie, endocrinologie moléculaire et maladies rares, CPBE, groupement hospitalier Lyon-Est, Lyon-Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France; Unité Inserm 1208, Lyon, France
| | - Célia Ravel
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Véronika Grzegorczyk-Martin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, clinique Mathilde, 76100 Rouen, France
| | - Éric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France
| | - Hugo G A Dupuis
- Service d'urologie et d'andrologie, CHU - hôpitaux de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| | - Tiphaine Lefebvre
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Florence Leperlier
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Léna Bardet
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Imane Lalami
- Service de gynécologie-obstétrique et de médecine de la reproduction, grand hôpital de l'Est Francilien - site de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - Camille Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Virginie Simon
- Unité fonctionnelle de gynécologie endocrinienne, service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Laura Dijols
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Bretonneau, CHU de Tours, Tours, France
| | - Justine Riss
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Antoine Koch
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Clément Bailly
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Constance Rio
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Marine Lebret
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76000 Rouen, France
| | - Margaux Jegaden
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Luc Pouly
- Service de gynécologie chirurgicale, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Antoine Torre
- Centre d'assistance médicale à la procréation clinicobiologique, centre hospitalier Sud Francilien Corbeil-Essonnes, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - Joëlle Belaisch-Allart
- Service de médecine de la reproduction, pôle Femme-Enfant, Centre hospitalier des 4 villes, rue Charles-Lauer, 92210 Saint-Cloud, France
| | - Jean-Marie Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Blandine Courbiere
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; IMBE, CNRS, IRD, Aix-Marseille université, Avignon université, Marseille, France.
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El Omri G, Rais H, Lazrak O, Rachid M, Khmou M, El Khannoussi B, Heddat A. Epidermoid cyst discovered concomitant with torsion of the spermatic cord: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241245286. [PMID: 38595943 PMCID: PMC11003338 DOI: 10.1177/2050313x241245286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Testicular epidermoid cysts, accounting for 1%-2% of all testicular masses, present a diagnostic challenge often identified post-orchiectomy. Conservative surgery is recommended, emphasizing the need for accurate preoperative diagnosis. A 28-year-old patient with acute left scrotal pain, initially suggestive of testicular torsion, underwent intraoperative exploration revealing extra-vaginal torsion with an incidentally discovered 2-cm intra-testicular mass. Due to suspected malignancy, a total orchiectomy was performed. Pathological analysis confirmed an epidermoid cyst with normal postoperative tumor markers. The patient had a good postoperative outcome and underwent testicular prosthesis placement 3 months after the surgery. Epidermoid cysts, often identified incidentally during urgent scenarios, underscore the importance of accurate preoperative diagnosis. Conservative surgery remains the preferred approach, emphasizing the consideration of benign factors to prevent unnecessary orchiectomies.
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Affiliation(s)
- Ghassane El Omri
- Department of Urology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Hamza Rais
- Department of Urology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Omar Lazrak
- Department of Urology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Moussaab Rachid
- Department of Urology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Mouna Khmou
- Department of Pathological Anatomy, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Basma El Khannoussi
- Department of Pathological Anatomy, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Abdeljalil Heddat
- Department of Urology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
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4
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Croghan SM, Malak JW, Rohan P, Byrne C, McGrath A, Cullen IM, Davis NF. Diagnosis and management of indeterminate testicular lesions. Nat Rev Urol 2024; 21:7-21. [PMID: 37414958 DOI: 10.1038/s41585-023-00786-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/08/2023]
Abstract
The sophistication and accessibility of modern-day imaging result in frequent detection of small or equivocal lesions of the testes. Traditionally, diagnosis of a testicular lesion with any possibility of malignancy would usually prompt radical orchidectomy. However, awareness is growing that a substantial proportion of these lesions might be benign and that universal application of radical orchidectomy risks frequent overtreatment. Given the potentially profound effects of radical orchidectomy on fertility, endocrine function and psychosexual well-being, particularly in scenarios of an abnormal contralateral testis or bilateral lesions, organ-preserving strategies for equivocal lesions should be considered. Image-based active surveillance can be applied for indeterminate lesions measuring ≤15 mm with a low conversion rate to surgical treatment. However, these outcomes are early and from relatively small, selected cohorts, and concerns prevail regarding the metastatic potential of even small undiagnosed germ cell tumours. No consensus exists on optimal surveillance (short interval (<3 months) ultrasonography is generally adopted); histological sampling is a widespread alternative, involving inguinal delivery of the testis and excisional biopsy of the lesion, with preoperative marking or intraoperative ultrasonographic localization when necessary. Frozen section analysis in this context demonstrates excellent diagnostic accuracy. Histological results support that approximately two-thirds of marker-negative indeterminate solitary testicular lesions measuring ≤25 mm overall are benign. In summary, modern imaging detects many small indeterminate testicular lesions, of which the majority are benign. Awareness is growing of surveillance and organ-sparing diagnostic and treatment strategies with the aim of minimizing rates of overtreatment with radical orchidectomy.
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Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons, Dublin, Ireland.
- Department of Urology, Blackrock Clinic, Dublin, Ireland.
| | - Jamil W Malak
- Department of Surgery, Royal College of Surgeons, Dublin, Ireland
- Department of Urology, Blackrock Clinic, Dublin, Ireland
| | - Pat Rohan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Caoimhe Byrne
- Department of Radiology, Mater Hospital, Dublin, Ireland
| | - Andrew McGrath
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Ivor M Cullen
- Department of Urology & Andrology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Surgery, Royal College of Surgeons, Dublin, Ireland
- Department of Urology, Blackrock Clinic, Dublin, Ireland
- Department of Urology & Andrology, Beaumont Hospital, Dublin, Ireland
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5
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Liu Z, Xie J, Gao X, Lin Y, Sun M, Sun Y, Peng D, Xie H, Li X, Li Z, Cai T, Chen P, Wu Z, Guo S, Li Y, Zhang Z, Qin Z, Han H, He Z, Liu J, Fu W, Li S, Xia D, Wang X, Deng C, Xu Z, Zhou F, Yao K, Yu W, Ye Y, Liu Z. SAVE Testis-sparing score: a multicenter retrospective study of a novel predictive tool for quantifying testicular tumors. Int J Surg 2023; 109:4185-4198. [PMID: 37738014 PMCID: PMC10720877 DOI: 10.1097/js9.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Testis-sparing surgery (TSS) is a safe treatment for patients with benign testicular tumors. Presently, assessments for evaluating the suitability of TSS are poorly standardized, partially because testicular anatomical elements cannot be quantitatively described. MATERIALS AND METHODS The authors developed a scoring method known as the SAVE testis-sparing score based on four critical and accessible anatomical features of a testicular tumor. The SAVE score ranges from 0 to 8 and is divided into four risk classes ( low , medium , high , and extremely high ) to evaluate the feasibility of TSS, wherein low-risk indicates high feasibility and vice versa. This study included 444 testicular tumor patients from eight centers. Among them, 216 patients (model group: 151 patients, validation group: 65 patients) were included in the modeling analysis, and the other 228 patients from children's centers were included in the proportion analysis. Using retrospective data, patient characteristics associated with surgical methods were identified. Furthermore, a multivariate logistic regression model was built quantify the associations between these characteristics and the surgery method. The receiver operator characteristic curve was used to evaluate the classification efficiency of SAVE. RESULTS The SAVE testis-sparing score includes size (tumor size as maximal diameter), available testicular tissue volume, volume ratio of the tumor to the testis, and the exophytic / endophytic properties of the tumor. The SAVE scoring system accurately classified the suitability of TSS based on the complexity of benign testicular tumors. CONCLUSION The SAVE score is a reproducible and robust tool for quantitatively describing the anatomical characteristics of benign testicular tumors and guide the preoperative evaluation of TSS.
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Affiliation(s)
- Zhenhua Liu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Junyi Xie
- Department of Urology, Peking University First Hospital; The Institution of Urology, Peking University; Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center; National Urological Cancer Center, Beijing
| | - Xiaofeng Gao
- Department of Pediatric Urology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health
| | - Yuan Lin
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Mengkui Sun
- Department of Urology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province
| | - Yubo Sun
- Department of Pediatric Urology, Children’s Hospital of Fudan University, Shanghai
| | - Ding Peng
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province
| | - Haibiao Xie
- Department of Urology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou
| | - Xiangdong Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Zhiyong Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Taonong Cai
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Pengyu Chen
- Department of Urology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province
| | - Zhiming Wu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Shengjie Guo
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Yonghong Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Zhilin Zhang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Zike Qin
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Hui Han
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Zhisong He
- Department of Urology, Peking University First Hospital; The Institution of Urology, Peking University; Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center; National Urological Cancer Center, Beijing
| | - Jiumin Liu
- Department of Urology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou
| | - Wen Fu
- Department of Pediatric Urology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health
| | - Shoulin Li
- Department of Urology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province
| | - Dan Xia
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province
| | - Xiang Wang
- Department of Pediatric Urology, Children’s Hospital of Fudan University, Shanghai
| | | | - Zhe Xu
- Department of Pediatric Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province
| | - Fangjian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Kai Yao
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Wei Yu
- Department of Urology, Peking University First Hospital; The Institution of Urology, Peking University; Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center; National Urological Cancer Center, Beijing
| | - Yunlin Ye
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
| | - Zhuowei Liu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou
- Department of Urology, Sun Yat-sen University Cancer Center Gansu Hospital, Lanzhou, Gansu Province, People’s Republic of China
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6
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Eisenberg ML, Esteves SC, Lamb DJ, Hotaling JM, Giwercman A, Hwang K, Cheng YS. Male infertility. Nat Rev Dis Primers 2023; 9:49. [PMID: 37709866 DOI: 10.1038/s41572-023-00459-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Clinical infertility is the inability of a couple to conceive after 12 months of trying. Male factors are estimated to contribute to 30-50% of cases of infertility. Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others. The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis. Treatments include lifestyle optimization, empirical or targeted medical therapy as well as surgical therapies that lead to measurable improvement in fertility. Although male infertility is recognized as a disease with effects on quality of life for both members of the infertile couple, fewer data exist on specific quantification and impact compared with other health-related conditions.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sandro C Esteves
- ANDROFERT Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Dolores J Lamb
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kathleen Hwang
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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7
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Arita Y, Morgan MA, Tsili AC, Yusuf GT. The Global Reading Room: A Testicular Lesion After Trauma. AJR Am J Roentgenol 2023; 221:386-387. [PMID: 36516006 DOI: 10.2214/ajr.22.28840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yuki Arita
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Athina C Tsili
- Department of Radiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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8
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Keske M, Canda AE, Karadag MA, Çiftçi H, Erturhan S, Kactan C, Soytas M, Özkaya F, Ozbey I, Ordek E, Atmaca AF, Yildirim A, Sahin S, Colakoglu Y, Boylu U, Erol B, Caskurlu T, Kiremit MC, Cakici OU, Sonmez G, Kılıçarslan H, Akbulut Z, Kaygısız O, Bedir S, Vuruskan H, Bozkurt YE, Aydin HR, Oguz U, Basok EK, Gumus BH, Tuncel A, Aslan Y, Hamidi N, Müslümanoğlu AY, Dinçer M, Balbay D, Albayrak S, Laguna MP. A Retrospective Analysis of 83 Patients with Testicular Mass Who Underwent Testis-Sparing Surgery: The Eurasian Uro-oncology Association Multicenter Study. Urol Int 2023; 107:857-865. [PMID: 37591208 DOI: 10.1159/000531645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/06/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Herein, we analyzed the histopathological, oncological and functional outcomes of testis-sparing surgery (TSS) in patients with distinct risk for testicular cancer. METHODS This is a multicenter retrospective study on consecutive patients who underwent TSS. Patients were categorized in high- or low-risk testicular germ cell tumor (TGCT) according to the presence/absence of features compatible with testicular dysgenesis syndrome. Histology was categorized per size and risk groups. RESULTS TSS was performed in 83 patients (86 tumors) of them, 27 in the high-risk group. Fifty-nine patients had a non-tumoral contralateral testis present. Sixty masses and 26 masses were benign and TGCTs, respectively. No statistical differences were observed in mean age (30.9 ± 10.32 years), pathological tumor size (14.67 ± 6.7 mm) between risk groups or between benign and malignant tumors (p = 0.608). When categorized per risk groups, 22 (73.3%) and 4 (7.1%) of the TSS specimens were malignant in the high- and low-risk patient groups, respectively. Univariate analysis showed that the only independent variable significantly related to malignant outcome was previous history of TGCT. During a mean follow-up of 25.5 ± 22.7 months, no patient developed systemic disease. Local recurrence was detected in 5 patients and received radical orchiectomy. Postoperative testosterone levels remained normal in 88% of those patients with normal preoperative level. No erectile dysfunction was reported in patients with benign lesions. CONCLUSION TSS is a safe and feasible approach with adequate cancer control, and preservation of sexual function is possible in 2/3 of patients harboring malignancy. Incidence of TGCT varies extremely between patients at high and low risk for TGCT requiring a careful consideration and counseling.
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Affiliation(s)
- Murat Keske
- University of Health Sciences Medical Faculty of Kayseri, Kayseri City Hospital, Kayseri, Turkey
| | | | - Mert Ali Karadag
- University of Health Sciences Medical Faculty of Kayseri, Kayseri City Hospital, Kayseri, Turkey
| | - Halil Çiftçi
- Department of Urology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Sakip Erturhan
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Cagri Kactan
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Soytas
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Fatih Özkaya
- Department of Urology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Isa Ozbey
- Department of Urology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Eser Ordek
- Department of Urology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Memorial Ankara Hospital, Ankara, Turkey
| | - Asif Yildirim
- Department of Urology, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences Affiliated with Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yunus Colakoglu
- Department of Urology, University of Health Sciences Affiliated with Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ugur Boylu
- Department of Urology, İstinye University Faculty of Medicine, Istanbul, Turkey
| | - Bulent Erol
- Department of Urology, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Turhan Caskurlu
- Department of Urology, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Ozer Ural Cakici
- Department of Urology, Medical Park Ankara Hospital, Ankara, Turkey
| | - Gokhan Sonmez
- Department of Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hakan Kılıçarslan
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Ziya Akbulut
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Onur Kaygısız
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Selahattin Bedir
- Department of Urology, University of Health Sciences Affiliated with Gulhane Training and Research Hospital, Ankara, Turkey
| | - Hakan Vuruskan
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Yunus Erol Bozkurt
- Department of Urology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Hasan Riza Aydin
- Department of Urology, University of Health Sciences Affiliated with Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ural Oguz
- Department of Urology, Giresun University, School of Medicine, Giresun, Turkey
| | - Erem Kaan Basok
- Department of Urology, Medical Park Izmir Hospital, Izmir, Turkey
| | - Bilal Habes Gumus
- Department of Urology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Altug Tuncel
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | - Yilmaz Aslan
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | - Nurullah Hamidi
- Department of Urology, Ankara Abdurrahman Yurtaslan Oncology Hospital, Ankara, Turkey
| | | | - Murat Dinçer
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Derya Balbay
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Selami Albayrak
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Maria Pilar Laguna
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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9
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Maiolino G, Fernández-Pascual E, Ochoa Arvizo MA, Vishwakarma R, Martínez-Salamanca JI. Male Infertility and the Risk of Developing Testicular Cancer: A Critical Contemporary Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1305. [PMID: 37512119 PMCID: PMC10383207 DOI: 10.3390/medicina59071305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The relationship between male infertility (MI) and testicular cancer (TC) is bilateral. On one hand, it is well-established that patients diagnosed with TC have a high risk of pre- and post-treatment infertility. On the other hand, the risk of developing TC in male infertile patients is not clearly defined. The objective of this review is to analyze the histopathological, etiological, and epidemiological associations between MI and the risk of developing testicular cancer. This review aims to provide further insights and offer a guide for assessing the risk factors for TC in infertile men. Materials and Methods: A comprehensive literature search was conducted to identify relevant studies discussing the relationship between MI and the risk of developing TC. Results: The incidence rates of germ cell neoplasia in situ (GCNIS) appear to be high in infertile men, particularly in those with low sperm counts. Most epidemiological studies have found a statistically significant risk of developing TC among infertile men compared to the general or fertile male populations. The concept of Testicular Dysgenesis Syndrome provides an explanatory model for the common etiology of MI, TC, cryptorchidism, and hypospadias. Clinical findings such as a history of cryptorchidism could increase the risk of developing TC in infertile men. Scrotal ultrasound evaluation for testis lesions and microlithiasis is important in infertile men. Sperm analysis parameters can be useful in assessing the risk of TC among infertile men. In the future, sperm and serum microRNAs (miRNAs) may be utilized for the non-invasive early diagnosis of TC and GCNIS in infertile men. Conclusions: MI is indeed a risk factor for developing testicular cancer, as demonstrated by various studies. All infertile men should undergo a risk assessment using clinical examination, ultrasound, and semen parameters to evaluate their risk of TC.
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Affiliation(s)
- Giuseppe Maiolino
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129 Perugia, Italy
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Esaú Fernández-Pascual
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Mario Alberto Ochoa Arvizo
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, 28222 Madrid, Spain
| | - Ranjit Vishwakarma
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Juan Ignacio Martínez-Salamanca
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, 28222 Madrid, Spain
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10
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Chavarriaga J, Hamilton R. Small Testicular Masses: Contemporary Diagnostic and Treatment Strategies, Future Directions, and Knowledge Gaps. Urol Oncol 2023:S1078-1439(23)00081-9. [PMID: 36990940 DOI: 10.1016/j.urolonc.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
The incidental discovery of small masses in the testicles of young men is becoming an increasing clinical dilemma. We are learning that the malignancy rate in masses ≤ 2 cm is much lower than traditionally thought and could be as low as 13% to 21%. The challenge remains in identifying which of these patients harbor malignant tumors that need to be treated, and benign lesions that could be safely surveilled. The aim of this narrative review is to discuss the current scientific evidence, diagnostic work-up, and treatment strategies for small testicular masses. We also discuss selection criteria, follow-up schedules and triggers for intervention for the surveillance of these small testis masses. Furthermore, we give a set of recommendations for assessing and treating these patients, based on the available literature and our experience at a dedicated testicular cancer clinic.
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11
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Wardak S, Pang KH, Castiglione F, Lindsay J, Walkden M, Ho DH, Kirkham A, Hadway P, Nigam R, Rees R, Alifrangis C, Alnajjar HM, Muneer A. Management of small testicular masses: outcomes from a single-centre specialist multidisciplinary team. BJU Int 2023; 131:73-81. [PMID: 35986901 DOI: 10.1111/bju.15874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To report the management outcomes of men with ≤20-mm small testicular masses (STMs) and to identify clinical and histopathological factors associated with malignancy. PATIENTS AND METHODS A retrospective analysis of men managed at a single centre between January 2010 and December 2020 with a STM ≤20 mm in size was performed. RESULTS Overall, 307 men with a median (interquartile range [IQR]) age of 36 (30-44) years were included. Of these, 161 (52.4%), 82 (26.7%), 62 (20.2%) and 2 men (0.7%) underwent surveillance with interval ultrasonography (USS), primary excisional testicular biopsy (TBx) or primary radical orchidectomy (RO), or were discharged, respectively. The median (IQR) surveillance duration was 6 (3-18) months. The majority of men who underwent surveillance had lesions <5 mm (59.0%) and no lesion vascularity (67.1%) on USS. Thirty-three (20.5%) men undergoing surveillance had a TBx based on changes on interval USS or patient choice; seven (21.2%) were found to be malignant. The overall rate of malignancy in the surveillance cohort was 4.3%. The majority of men who underwent primary RO had lesions ≥10 mm (85.5%) and the presence of vascularity (61.7%) on USS. Nineteen men (23.2%) who underwent primary TBx (median lesion size 6 mm) had a malignancy confirmed on biopsy and underwent RO. A total of 88 men (28.7%) underwent RO, and malignancy was confirmed in 73 (83.0%) of them. The overall malignancy rate in the whole STM cohort was 23.8%. Malignant RO specimens had significantly larger lesion sizes (median [IQR] 11 [8-15] mm, vs benign: median [IQR] 8 [5-10] mm; P = 0.04). CONCLUSIONS Small testicular masses can be stratified and managed based on lesion size and USS features. The overall malignancy rate in men with an STM was 23.8% (4.3% in the surveillance group). Surveillance should be considered in lesions <10 mm in size, with a TBx or frozen-section examination offered prior to RO in order to preserve testicular function.
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Affiliation(s)
- Shafi Wardak
- Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UK.,Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Karl H Pang
- Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fabio Castiglione
- Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jamie Lindsay
- Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Miles Walkden
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dan Heffernan Ho
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Hadway
- Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UK.,Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Raj Nigam
- Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Rowland Rees
- Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Constantine Alifrangis
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hussain M Alnajjar
- Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Asif Muneer
- Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
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12
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Dieckmann KP, Isbarn H, Grobelny F, Dumlupinar C, Utschig J, Wülfing C, Pichlmeier U, Belge G. Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates-A Comprehensive Statistical Analysis. Cancers (Basel) 2022; 14:5447. [PMID: 36358866 PMCID: PMC9653836 DOI: 10.3390/cancers14215447] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
The role of primary tumour size (TS) in the clinical course of testicular tumours is incompletely understood. We retrospectively evaluated 641 consecutive patients with testicular neoplasms with regard to TS, histology, clinical stage (CS), serum tumour marker (STM) expression and patient age using descriptive statistical methods. TS ≤ 10 mm was encountered in 13.6% of cases. Median TS of 10 mm, 30 mm, 35 mm, and 53 mm were found in benign tumours, seminomas, nonseminomas, and other malignant tumours, respectively. In cases with TS ≤ 10 mm, 50.6% had benign tumours. Upon receiver operating characteristics analysis, TS of > 16 mm revealed 81.5% sensitivity and 81.0% specificity for detecting malignancy. In subcentimeter germ cell tumours (GCTs), 97.7% of cases had CS1, and CS1 frequency dropped with increasing TS. Expression rates of all STMs significantly increased with TS. MicroRNA-371a-3p (M371) serum levels had higher expression rates than classical STMs, with a rate of 44.1% in subcentimeter GCTs. In all, TS is a biologically relevant factor owing to its significant associations with CS, STM expression rates and histology. Importantly, 50% of subcentimeter testicular neoplasms are of benign nature, and M371 outperforms the classical markers even in subcentimeter tumours.
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Affiliation(s)
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Francesca Grobelny
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Cansu Dumlupinar
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry und Epidemiology, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Gazanfer Belge
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
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13
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Color doppler ultrasound for diagnosis of testicular carcinoma: A comparison with gold standard histopathology. Ann Med Surg (Lond) 2022; 84:104938. [DOI: 10.1016/j.amsu.2022.104938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/27/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022] Open
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14
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Murez T, Fléchon A, Branger N, Savoie PH, Rocher L, Camparo P, Neuville P, Ferretti L, Van Hove A, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: testicular germ cell cancer. Prog Urol 2022; 32:1066-1101. [DOI: 10.1016/j.purol.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022]
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15
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Pratsinis M, Rothermundt C, Fankhauser C. Reply to Julian Chavarriaga and Robert Hamilton's Letter to the Editor re: Manolis Pratsinis, Christian Fankhauser, Katerina Pratsinis, et al. Metastatic Potential of Small Testicular Germ Cell Tumors: Implications for Surveillance of Small Testicular Masses. Eur Urol Open Sci 2022;40:16-8. Should We Be Afraid of Surveillance? Clinically Meaningful Reasons Why Offering Surveillance for Incidentally Detected Small Testicular Masses Remains a Safe Approach. EUR UROL SUPPL 2022; 45:52. [PMID: 36212981 PMCID: PMC9535262 DOI: 10.1016/j.euros.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
- Manolis Pratsinis
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland,Corresponding author at: Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Christian Rothermundt
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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16
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Gobbo A, Negri L, Casale P, Fasulo V, Lughezzani G, Saitta C, Benaglia R, Buffi NM, Levi Setti P. Is testis sparing surgery safe in patients with incidental small testicular lesions referring to a fertility center? A retrospective analysis reporting factors correlated to malignancy and long-term oncological outcomes. Urol Oncol 2022; 40:457.e9-457.e16. [PMID: 36075820 DOI: 10.1016/j.urolonc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/28/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To define predictors of malignancy after Testis sparing surgery (TSS) in patients referring to a fertility center with incidental small testicular lesions. Sub analyses were performed to assess predictors of Leydig cell hyperplasia and Leydig cell tumor. MATERIALS AND METHODS We performed a retrospective analysis of a single institutional database including patients treated with TSS between 2002 and 2020. All patients who underwent TSS as a first line surgical approach for incidentally detected lesions found during fertility evaluation were included. RESULTS Data of 64 patients were collected. The median follow up was 58 months and no recurrences were observed. At univariable logistic regression multifocal lesions, hypervascularization, microlithiasis, age and lesion size were significantly associated with malignancy. At multivariable logistic regression lesion dimension, hypervascularization and multifocal lesions were predictors of malignancy. Lesions smaller than 5 mm proved to be benign in 96.6% of the cases (32/33). Intraoperative color of the lesion and US pattern of vascularization were predictors at multivariable logistic regression for Leydig cell hyperplasia and Leydig cell tumor. CONCLUSION Ultrasonographic characteristics and intraoperative appearance of the lesion can predict the malignant nature of small testicular lesions, guiding their surgical management in patients referring to a fertility center. Based on our experience, clinicians may safely perform TSS in carefully selected patients.
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Affiliation(s)
- Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Luciano Negri
- Department of Gynecology, Division of Gynecology and Reproductive Medicine-Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Renzo Benaglia
- Department of Gynecology, Division of Gynecology and Reproductive Medicine-Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Levi Setti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Gynecology, Division of Gynecology and Reproductive Medicine-Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Chavarriaga J, Hamilton R. Re: Manolis Pratsinis, Christian Fankhauser, Katerina Pratsinis, et al. Metastatic Potential of Small Testicular Germ Cell Tumors: Implications for Surveillance of Small Testicular Masses. Eur Urol Open Sci 2022;40:16-18: Should We Be Afraid of Surveillance? Clinically Meaningful Reasons Why Offering Surveillance for Incidentally Detected Small Testicular Masses Remains a Safe Approach. EUR UROL SUPPL 2022; 45:53-54. [PMID: 36199619 PMCID: PMC9527622 DOI: 10.1016/j.euros.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Julian Chavarriaga
- Corresponding author. Division of Urology, Department of Surgery, Princess Margaret Hospital Cancer Centre, Toronto, Canada.
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18
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Prevalence and Management of Incidental Testicular Masses-A Systematic Review. J Clin Med 2022; 11:jcm11195770. [PMID: 36233639 PMCID: PMC9573452 DOI: 10.3390/jcm11195770] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Management of incidentally diagnosed small testicular masses (STM) is controversial. Although there is the risk of malignancy, it might be realistic to safely seek preservation of testicles bearing benign masses. This study aims to systematically evaluate the evidence regarding prevalence of STMs, their benign or malignant histology and their management. We conducted a systematic literature search for studies reporting small or incidental testicular masses and their management by radical orchiectomy, testis sparing surgery (TSS) or ultrasound (US) surveillance. We initially screened 2126 abstracts and from these, 57 studies met the inclusion criteria. Testicular masses were detected in 1.74% of patients undergoing US examination. Regarding STMs removed by surgery, 41.12% were benign. Intraoperative frozen section examination (FSE) is a reliable tool to discriminate between benign and malignant testicular masses (average 93.05% accuracy), supporting TSS. Benign lesions were associated with smaller diameter (<1 cm 68.78% benign), were often hypoechoic and exhibited regular margins on US. Conclusions: Small testicular masses are often benign. Clinical and US patterns are not accurate enough for including patients in surveillance protocols and TSS paired with FSE is pivotal for precluding the removal of testicles bearing benign lesions. Future research might unveil new imaging tools or biomarkers to support clinical management.
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The Diagnostic Value of the Added MR Imaging of the Scrotum in the Preoperative Workup of Sonographically Indeterminate Testicular Lesions—A Retrospective Multicenter Analysis. Cancers (Basel) 2022; 14:cancers14153594. [PMID: 35892855 PMCID: PMC9330050 DOI: 10.3390/cancers14153594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/25/2023] Open
Abstract
Background: The purpose of this study was to retrospectively analyze the diagnostic accuracy of magnetic resonance imaging (MRI) examinations of the scrotum in comparison with standard ultrasound (US) and histopathology. Methods: A retrospective multi-center analysis of MRI examinations of the scrotum performed between 06/2008 and 04/2021 was conducted. Results: A total of n = 113 patients were included. A total of 53 histopathologies were available, with 52.8% malignant and 50.9% benign findings. Related to histopathology, imaging was true negative, false negative, false positive, and true positive in 4.1%, 2.1%, 25.0% and 37.5% for standard ultrasound (US) and 9.1%, 1.8%, 25.5% and 43.6% for MRI. Sensitivity, specificity, positive predictive value and negative predictive value were 94.7%, 20.0%, 36.0% and 88.9% for US and 85.7%, 72.8%, 52.1% and 93.7% for MRI, respectively. Benign lesions were significantly smaller than malignant ones in standard US (p = 0.001), histopathology (p = 0.001) and MRI (p = 0.004). The size of malignant tumors did not differ significantly between histopathology and standard US (0.72) and between histopathology and MRI (p = 0.88). Conclusions: MRI shows good sensitivity and specificity for the estimation of testicular tumors in this collective. Benign lesions are significantly smaller than malignant ones. Both MRI and US can estimate the size of malignant tumors adequately.
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20
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Corcioni B, Brandi N, Marasco G, Gaudiano C, De Cinque A, Ciccarese F, Ercolino A, Schiavina R, Brunocilla E, Renzulli M, Golfieri R. Multiparametric Ultrasound for the diagnosis of Leydig cell tumours in non‐palpable testicular lesions. Andrology 2022; 10:1387-1397. [DOI: 10.1111/andr.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Beniamino Corcioni
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Nicolò Brandi
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Giovanni Marasco
- Internal Medicine and Digestive Physiopathology Unit IRCCS Azienda Ospedaliero‐Universitaria di Bologna Bologna Italia
| | - Caterina Gaudiano
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Antonio De Cinque
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Federica Ciccarese
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Amelio Ercolino
- Division of Urology IRCCS, Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
| | - Riccardo Schiavina
- Division of Urology IRCCS, Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
| | - Eugenio Brunocilla
- Division of Urology IRCCS, Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
| | - Matteo Renzulli
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
| | - Rita Golfieri
- Department of Radiology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Via Albertoni 15 Bologna Italia
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21
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Dupeux M, Maxwell F, Rocher L, Izard V, Guettier C, Ferlicot S. Testicular Lesions in Infertile Men. Am J Clin Pathol 2022; 157:936-941. [PMID: 34935941 DOI: 10.1093/ajcp/aqab214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES An increasing number of incidental testicular tumors are diagnosed in patients during infertility workup. The aim of this study was to evaluate the accuracy of frozen section examination (FSE) for the management of these tumors. METHODS We retrospectively studied a series of 46 testicular tumors diagnosed during exploration for infertility from 2000 to 2019 and submitted for FSE. RESULTS A diagnosis of malignancy was made in 23 cases on both gross examination (yellow-white or cream-colored nodules for seminomas) and FSE, then confirmed on final diagnosis in 22 of the cases. One seminoma reported on FSE was revised as being a Leydig cell tumor. The 23 other lesions were diagnosed as benign on FSE, including 11 Leydig cell tumors (yellow-brown nodules), 2 Leydig cell hyperplasias, and 10 whitish fibrous lesions. All Leydig cell lesions were confirmed except 1, which was reclassified as a Sertoli cell tumor. Of the 10 cases of fibrous lesions, 6 were associated with malignancy. CONCLUSIONS The high incidence of Leydig cell tumors and the accuracy of FSE for these lesions demonstrate the interest in FSE. In contrast, FSE is not reliable for fibrous lesions, and surgeons should be aware that a fibrosis result often corresponds with regressed tumors.
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Affiliation(s)
- Margot Dupeux
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
| | - Florian Maxwell
- Department of Radiology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
| | - Laurence Rocher
- Department of Radiology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris Saclay, Ecole Doctorale Biosigne, ED 419 , Le Kremlin-Bicêtre , France
- Institut Langevin , Paris , France
| | - Vincent Izard
- Department of Urology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
| | - Catherine Guettier
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
| | - Sophie Ferlicot
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
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22
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Pratsinis M, Fankhauser C, Pratsinis K, Beyer J, Bührer E, Cathomas R, Fischer N, Hermanns T, Hirschi-Blickenstorfer A, Kamradt J, Alex Kluth L, Zihler D, Mingrone W, Müller B, Nestler T, Rothschild SI, Seifert B, Templeton AJ, Terbuch A, Ufen MP, Woelky R, Gillessen S, Rothermundt C. Metastatic Potential of Small Testicular Germ Cell Tumors: Implications for Surveillance of Small Testicular Masses. EUR UROL SUPPL 2022; 40:16-18. [PMID: 35515270 PMCID: PMC9062248 DOI: 10.1016/j.euros.2022.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
Patient summary
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23
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Ferlin A, Calogero AE, Krausz C, Lombardo F, Paoli D, Rago R, Scarica C, Simoni M, Foresta C, Rochira V, Sbardella E, Francavilla S, Corona G. Management of male factor infertility: position statement from the Italian Society of Andrology and Sexual Medicine (SIAMS) : Endorsing Organization: Italian Society of Embryology, Reproduction, and Research (SIERR). J Endocrinol Invest 2022; 45:1085-1113. [PMID: 35075609 DOI: 10.1007/s40618-022-01741-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Infertility affects 15-20% of couples and male factors are present in about half of the cases. For many aspects related to the diagnostic and therapeutic approach of male factor infertility, there is no general consensus, and the clinical approach is not uniform. METHODS In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), endorsed by the Italian Society of Embryology, Reproduction, and Research (SIERR), we propose evidence-based recommendations for the diagnosis, treatment, and management of male factor infertility to improve patient and couple care. RESULTS Components of the initial evaluation should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, and imaging are suggested in most men and recommended when specific risk factors for infertility exist or first-step analyses showed abnormalities. Full examination including genetic tests, testicular cytology/histology, or additional tests on sperm is clinically oriented and based on the results of previous investigations. For treatment purposes, the identification of the specific cause and the pathogenetic mechanism is advisable. At least, distinguishing pre-testicular, testicular, and post-testicular forms is essential. Treatment should be couple-oriented, including lifestyle modifications, etiologic therapies, empirical treatments, and ART on the basis of best evidence and with a gradual approach. CONCLUSION These Guidelines are based on two principal aspects: they are couple-oriented and place high value in assessing, preventing, and treating risk factors for infertility. These Guidelines also highlighted that male infertility and in particular testicular function might be a mirror of general health of a man.
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Affiliation(s)
- A Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy.
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - C Krausz
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - F Lombardo
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - D Paoli
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - R Rago
- Department of Gender, Parenting, Child and Adolescent Medicine, Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy
| | - C Scarica
- European Hospital, Centre for Reproductive Medicine, Rome, Italy
| | - M Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - C Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Sbardella
- Department of Experimental Medicine, University of Rome "La Sapienza", Rome, Italy
| | - S Francavilla
- Department of Life, Health and Environmental Sciences, Unit of Andrology, University of L'Aquila, L'Aquila, Italy
| | - G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
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24
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Wakileh GA, Ruf C, Heidenreich A, Dieckmann KP, Lisson C, Prasad V, Bolenz C, Zengerling F. Contemporary options and future perspectives: three examples highlighting the challenges in testicular cancer imaging. World J Urol 2021; 40:307-315. [PMID: 34779884 PMCID: PMC8921012 DOI: 10.1007/s00345-021-03856-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/04/2021] [Indexed: 10/27/2022] Open
Abstract
PURPOSE One of the main issues in testicular germ cell tumors (TGCTs) management is to reduce the necessary amount of treatment to achieve cure. Excess treatment burden may arise from late diagnosis of the primary as well as from false positive or negative staging results. Correct imaging is of paramount importance for successful management of TGCT. The aim of this review is to point out the current state of the art as well as innovative developments in TGCT imaging on the basis of three common challenging clinical situations. METHODS A selective literature search was performed in PubMed, Medline as well as in recent conference proceedings. RESULTS Regarding small testicular lesions, recent studies using elastography, contrast-enhanced ultrasound or magnetic resonance imaging (MRI) showed promising data for differentiation between benign and malignant histology. For borderline enlarged lymph nodes FDG-PET-CT performance is unsatisfactory, promising new techniques as lymphotropic nanoparticle-enhanced MRI is the subject of research in this field. Regarding the assessment of postchemotherapeutic residual masses, the use of conventional computerized tomography (CT) together with serum tumor markers is still the standard of care. To avoid overtreatment in this setting, new imaging modalities like diffusion-weighted MRI and radiomics are currently under investigation. For follow-up of clinical stage I TGCTs, the use of MRI is non-inferior to CT while omitting radiation exposure. CONCLUSION Further efforts should be made to refine imaging for TGCT patients, which is of high relevance for the guidance of treatment decisions as well as the associated treatment burdens and oncological outcomes.
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Affiliation(s)
- Gamal Anton Wakileh
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Christian Ruf
- Department of Urology, Armed Forces Hospital Ulm, Ulm, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, Cologne University Hospital, Cologne, Germany
| | | | - Catharina Lisson
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
| | - Christian Bolenz
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
| | - Friedemann Zengerling
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
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25
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Abstract
Male infertility is responsible for 50% of men's health problems and has always been a concern for personal and social issues. A survey of global statistics suggests an increase in infertility rate as one of the critical issues documented in studies. There are different ways of maintaining fertility in men, depending on their age. In this paper, we review the preservation methods used for fertility treatment in Iran and other countries. Available data were reviewed from Google Scholar, PubMed, Scopus, Web of Science, IranMedex, MEDLIB, IranDoc and Scientific Information Database and searched for articles published up to 2018, using the medical subject heading (MeSH) terms for cryopreservation, sperm, testicular, spermatogonia stem cell, male infertility and/or Iranian and in the world, to provide evidence from evaluation of fertility preservation the methods. Based the search strategy, 274 manuscripts were found. After reviewing the titles, abstracts and manuscripts in their entirety, 119 articles were obtained and selected according to the eligibility criteria. The 85 studies mentioned above were divided into three categories (sperm, testis, and spermatogonia stem cells (SSCs)), and methods of fertility preservation were investigated. Ways to maintain male fertility were different depending on age, and included sperm, testicular, and SSC freezing. The number of studies on testicular tissue and SSCs was low for human samples, and more studies are still needed. Sperm freezing at infertility centres is the top for male fertility preservation.
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26
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Lewicki A, Freeman S, Jędrzejczyk M, Dobruch J, Dong Y, Bertolotto M, Dietrich CF. Incidental Findings and How to Manage Them: Testis- A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2787-2802. [PMID: 34303560 DOI: 10.1016/j.ultrasmedbio.2021.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 06/13/2023]
Abstract
Testicular incidentalomas are non-palpable, asymptomatic lesions, most frequently detected on ultrasound examinations. Each incidentaloma should undergo a standardized diagnostic workup to exclude malignancy and recognize other potentially significant non-malignant conditions that may first present with an incidental finding on scrotal ultrasound. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on management of testicular incidentalomas and describes efficient management strategies with particular reference to the role of ultrasound techniques.
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Affiliation(s)
- Andrzej Lewicki
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Simon Freeman
- Imaging Directorate, Derriford Hospital, University Hospitals Plymouth NHS Trust. Derriford Road, Plymouth, Devon, United Kingdom
| | - Maciej Jędrzejczyk
- Department of Diagnostic Imaging, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
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Narayan Y, Brown D, Ivaz S, Das K, Moussa M, Tsampoukas G, Papatsoris A, Buchholz N. Incidental testicular masses and the role of organ-sparing approach. Arch Ital Urol Androl 2021; 93:296-300. [PMID: 34839628 DOI: 10.4081/aiua.2021.3.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The widespread use of ultrasonography for the investigation of common urological conditions, such as infertility or pain, has resulted in an increased incidence of incidental non-palpable testicular masses. The majority of these are expected to be benign therefore a conservative approach, either active monitoring or organsparing approach, is recommended. However, there are no clinical or radiological parameters which define the exact nature of such lesions and optimal patient selection criteria are lacking. In this comprehensive review we discuss the significance of incidental, small testicular masses (STMs) and the role of organ-sparing approach in the management of these lesions. MATERIALS AND METHODS A non-systematic search was performed using PubMed to identify articles that covered the following topics; clinical implications at diagnosis, role of imaging in identifying the malignant capabilities of a lesion, role of surgery and the final pathology. RESULTS Incidental STMs are routinely identified following ultrasound examination of infertile men. STMs usually measure a few millimeters in size and the majority of these are benign. Therefore, strict follow up or an organ-sparing approach, with utilisation of frozen section analysis (FSA), is favored for STMs. FSA has a high correlation with final pathology and prevents unnecessary orchidectomies. Advances in imaging, namely ultrasound and magnetic resonance imaging may provide enhanced assessment of STMs and guidance intraoperatively. CONCLUSIONS The optimal approach is not well defined and there is no specific clinical parameter that can predict the nature of STMs. The increasing incidence of small, benign testicular masses has resulted in the development of organ-sparing surgery to investigate and manage these lesions. Organ-sparing surgery has been shown to be practical and carries excellent oncological outcomes.
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Affiliation(s)
- Yash Narayan
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Dominic Brown
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Stella Ivaz
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Krishanu Das
- U-merge Ltd. (Urology for emerging countries), London, UK; Consultant Urologist, Bahrain Specialist Hospital.
| | - Mohamad Moussa
- Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Georgios Tsampoukas
- Department of Urology, Princess Alexandra Hospital, Harlow; U-merge Ltd. (Urology for emerging countries), London.
| | - Athanasios Papatsoris
- U-merge Ltd. (Urology for emerging countries), London, UK; Consultant Urologist, Bahrain Specialist Hospital.
| | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London.
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Ory J, Blankstein U, Gonzalez DC, Sathe AA, White JT, Delgado C, Reynolds J, Jarvi K, Ramasamy R. Outcomes of organ-sparing surgery for adult testicular tumors: A systematic review of the literature. BJUI COMPASS 2021; 2:306-321. [PMID: 34568872 PMCID: PMC8462801 DOI: 10.1002/bco2.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective To perform a systematic review on the effects of testicular sparing surgery (TSS) on the oncological, functional, and hormonal outcomes of adults with testicular tumors. Methods A literature search was performed after PROSPERO registration (CRD42020200842) and reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methods. We conducted a systematic search of Medline (Ovid), Embase, Cochrane CENTRAL, CINAHL, Scopus, Web of Science, ClinicalTrials.gov, and the WHO/ICTRP from inception to November 20, 2020. Manuscripts and published abstracts were included if they involved testis-sparing surgery (TSS) and contained data on any outcomes related to fertility, hormonal parameters, or oncological control, or if they evaluated surgical technique. Results Our initial search yielded 3,370 manuscripts, with 269 of these screened for full-text eligibility. After our exclusion criteria were applied, 32 studies were included in the final analysis. Oncological outcomes were obtained from 12 studies (average follow-up 57.8 months), functional data from 26 studies (average follow-up 49.6 months), fertility information from 10 studies (average follow-up 55.8 months), and data on nonpalpable tumors from 11 studies (average follow-up 32.1 months). Oncological control appears to be excellent in studies that reported these outcomes. Presence of germ cell neoplasia in situ was controlled with adjuvant radiation in nearly all cases. Functional outcomes are also promising, as development of primary and compensated hypogonadism was rare. Semen parameters are poor preoperatively among men with benign and malignant testis tumors, with occasional decline after TSS. Frozen section analysis at the time of surgery appears to be very reliable, and the majority of nonpalpable tumors appear to be benign. Conclusions TSS is a safe and efficacious technique with regards to oncological control and postoperative hormonal function based on retrospective, noncontrolled studies. TSS avoids unnecessary removal of benign testicular tissue, and should be given serious consideration in cases of nonpalpable, small tumors under 2 cm. In cases of malignancy, TSS can safely avoid anorchia in men with bilateral tumors and in men with solitary testicles. The use of the operating microscope, while theoretically promising, does not necessarily lead to better outcomes, however data are limited.
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Affiliation(s)
- Jesse Ory
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Udi Blankstein
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Daniel C Gonzalez
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Aditya A Sathe
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joshua T White
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Carlos Delgado
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Mexico
| | - John Reynolds
- Department of Health Informatics, Miller School of Medicine, University of Miami, Calder Memorial Library, Miami, FL, USA
| | - Keith Jarvi
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
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29
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Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, Cocci A, Corona G, Dimitropoulos K, Gül M, Hatzichristodoulou G, Jones TH, Kadioglu A, Martínez Salamanca JI, Milenkovic U, Modgil V, Russo GI, Serefoglu EC, Tharakan T, Verze P, Salonia A. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 2021; 80:603-620. [PMID: 34511305 DOI: 10.1016/j.eururo.2021.08.014] [Citation(s) in RCA: 223] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021. OBJECTIVE To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health, including advances and areas of controversy in male infertility. EVIDENCE ACQUISITION The panel performed a comprehensive literature review of novel data up to January 2021. The guidelines were updated and a strength rating for each recommendation was included that was based either on a systematic review of the literature or consensus opinion from the expert panel, where applicable. EVIDENCE SYNTHESIS The male partner in infertile couples should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors causing fertility impairment. Infertile men are at a higher risk of harbouring and developing other diseases including malignancy and cardiovascular disease and should be screened for potential modifiable risk factors, such as hypogonadism. Sperm DNA fragmentation testing has emerged as a novel biomarker that can identify infertile men and provide information on the outcomes from assisted reproductive techniques. The role of hormone stimulation therapy in hypergonadotropic hypogonadal or eugonadal patients is controversial and is not recommended outside of clinical trials. Furthermore, there is insufficient evidence to support the widespread use of other empirical treatments and surgical interventions in clinical practice (such as antioxidants and surgical sperm retrieval in men without azoospermia). There is low-quality evidence to support the routine use of testicular fine-needle mapping as an alternative diagnostic and predictive tool before testicular sperm extraction (TESE) in men with nonobstructive azoospermia (NOA), and either conventional or microdissection TESE remains the surgical modality of choice for men with NOA. CONCLUSIONS All infertile men should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors. Increasing data indicate that infertile men are at higher risk of cardiovascular mortality and of developing cancers and should be screened and counselled accordingly. There is low-quality evidence supporting the use of empirical treatments and interventions currently used in clinical practice; the efficacy of these therapies needs to be validated in large-scale randomised controlled trials. PATIENT SUMMARY Approximately 50% of infertility will be due to problems with the male partner. Therefore, all infertile men should be assessed by a specialist with the expertise to not only help optimise their fertility but also because they are at higher risk of developing cardiovascular disease and cancer long term and therefore require appropriate counselling and management. There are many treatments and interventions for male infertility that have not been validated in high-quality studies and caution should be applied to their use in routine clinical practice.
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Affiliation(s)
- Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | | | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Joana Carvalho
- CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal
| | - Nusret Can Cilesiz
- Department of Urology, Taksim Training & Research Hospital, Istanbul, Turkey
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Konstantinos Dimitropoulos
- Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Murat Gül
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | | | - Thomas Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK
| | - Ates Kadioglu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | | | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, UK
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Tharu Tharakan
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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Crocetto F, Arcaniolo D, Napolitano L, Barone B, La Rocca R, Capece M, Caputo VF, Imbimbo C, De Sio M, Calace FP, Manfredi C. Impact of Sexual Activity on the Risk of Male Genital Tumors: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168500. [PMID: 34444249 PMCID: PMC8392571 DOI: 10.3390/ijerph18168500] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 12/26/2022]
Abstract
Most cancers are related to lifestyle and environmental risk factors, including smoking, alcohol consumption, dietary habits, and environment (occupational exposures). A growing interest in the association between sexual activity (SA) and the development of different types of tumors in both men and women has been recorded in recent years. The aim of the present systematic review is to describe and critically discuss the current evidence regarding the association between SA and male genital cancers (prostatic, penile, and testicular), and to analyze the different theories and biological mechanisms reported in the literature. A comprehensive bibliographic search in the MEDLINE, Scopus, and Web of Science databases was performed in July 2021. Papers in the English language without chronological restrictions were selected. Retrospective and prospective primary clinical studies, in addition to previous systematic reviews and meta-analyses, were included. A total of 19 studies, including 953,704 patients were selected. Case reports, conference abstracts, and editorial comments were excluded. Men with more than 20 sexual partners in their lifetime, and those reporting more than 21 ejaculations per month, reported a decreased risk of overall and less aggressive prostate cancer (PCa). About 40% of penile cancers (PCs) were HPV-associated, with HPV 16 being the dominant genotype. Data regarding the risk of HPV in circumcised patients are conflicting, although circumcision appears to have a protective role against PC. Viral infections and epididymo-orchitis are among the main sex-related risk factors studied for testicular cancer (TC); however, data in the literature are limited. Testicular trauma can allow the identification of pre-existing TC. SA is closely associated with the development of PC through high-risk HPV transmission; in this context, phimosis appears to be a favoring factor. Sexual behaviors appear to play a significant role in PCa pathogenesis, probably through inflammatory mechanisms; however, protective sexual habits have also been described. A direct correlation between SA and TC has not yet been proven, although infections remain the most studied sex-related factor.
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Affiliation(s)
- Felice Crocetto
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Davide Arcaniolo
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (D.A.); (M.D.S.)
| | - Luigi Napolitano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
- Correspondence:
| | - Biagio Barone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Roberto La Rocca
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Marco Capece
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Vincenzo Francesco Caputo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Ciro Imbimbo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Marco De Sio
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (D.A.); (M.D.S.)
| | - Francesco Paolo Calace
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (D.A.); (M.D.S.)
| | - Celeste Manfredi
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (D.A.); (M.D.S.)
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Pinto SP, Huang DY, Dinesh AA, Sidhu PS, Ahmed K. A Systematic Review on the Use of Qualitative and Quantitative Contrast-enhanced Ultrasound in Diagnosing Testicular Abnormalities. Urology 2021; 154:16-23. [DOI: 10.1016/j.urology.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023]
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Abou Heidar N. Incidental discovery of azoospermia on work-up of testicular tumour: a practice changing discovery. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211024044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Testicular tumours are increasing in incidence, especially in developed countries. This incidence increases specifically in the subpopulation of infertile men. This case highlights a young man incidentally diagnosed with a subcentimetric testicular lesion, who was discovered to have concomitant azoospermia. The authors review management strategies in this challenging case, as treatment options for men with infertility and concomitant testicular tumours vary from men who are fertile. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Nassib Abou Heidar
- Department of Surgery, American University of Beirut Medical Center, Lebanon
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Potter AR, Prezzi D. Indeterminate Lesions of the Testis in Klinefelter Syndrome—Should We Be Concerned? FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:629418. [PMID: 36303953 PMCID: PMC9580716 DOI: 10.3389/frph.2021.629418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/31/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Davide Prezzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- *Correspondence: Davide Prezzi
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Mulawkar PM, Maheshwari PN, Agrawal SG. Clinical Andrologists: Do We Really Need Them in the Era of ART? J Hum Reprod Sci 2021; 14:105-112. [PMID: 34316224 PMCID: PMC8279053 DOI: 10.4103/jhrs.jhrs_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022] Open
Abstract
Infertility is on a rise, and so is the availability of assisted reproductive technique (ART) centres. The sole aim of these centers is to help these unfortunate couples achieve pregnancy. Hence, the concentration of the treatment is on the female partner, while the male is relegated to just being a source for sperm. In the era of intracytoplasmic sperm injection, when pregnancy is possible even with a single mature sperm, evaluation and management of male factor infertility (MFI) is often neglected. MFI and poor semen parameters are markers of male health. He could be suffering from erectile or ejaculatory issues or with correctable obstructive azoospermia. A simple timely varicocele correction may help resolve the issue. It is important to understand that MFI is not a disease but may be a symptom of major underlying clinical condition like testicular or brain tumors. Infertility treatment could be the only occasion when a male seeks health-care evaluation. India has a large pool of qualified urologists trained in andrological care. In contrast, gynecologists may not be trained in the management of male patients, hence there is an important place for andrological services to be an integral part of ART centers. Andrologists would offer minimal andrological evaluation and condition-specific treatment. This could avoid or reduce the need for invasive and expensive ART. Andrologists could also choose the most appropriate mode of sperm retrieval. Undoubtedly, availability of andrological services would improve the overall quality of care, reduce the costs and complications, and would also be medicolegally safe.
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Affiliation(s)
- Prashant Motiram Mulawkar
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, Maharashtra, India
- Department of Urology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Pankaj N. Maheshwari
- Department of Urology, Fortis Hospital, Mumbai, Maharashtra, India
- Department of Urology, Grant Medical College, Mumbai, Maharashtra, India
| | - Sumeet Gopal Agrawal
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, Maharashtra, India
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Brown D, Tsampoukas G, Popov EP, Aldin Z, Moussa M, Papatsoris A, Buchholz NNP. The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review. Arab J Urol 2021; 19:179-185. [PMID: 34104494 PMCID: PMC8158180 DOI: 10.1080/2090598x.2021.1885949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The increasing use of scrotal ultrasonography (US) for non-cancerous indications has led to greater detection of incidental, small testicular masses. Operative intervention is currently the mainstay of treatment for all testicular tumours; however, despite the low malignant potential of small, incidental masses, little is known about conservative management using radiological surveillance. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted and studies meeting the inclusion criteria were reviewed for patient outcomes. Results: A total of 293 patients across six studies underwent radiological surveillance for an incidental small testicular mass. Infertility was the main indication for investigation and all studies used US as the surveillance modality. A total of 37 patients (12.6%) underwent surgical exploration during follow-up, with only 10 (3.4%) found to have malignant disease at histology. Conclusions: Radiological surveillance of incidental small testicular masses is safe when used for select patient groups due to the high probability of benign disease, although optimal patient selection criteria and a well-defined protocol are lacking. This approach could be considered in patients with incidental, impalpable testicular masses of ≤5 mm in diameter displaying no significant size increase or internal vascularity on US and with negative tumour markers, as the probability of malignancy in these patients is low.
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Affiliation(s)
- Dominic Brown
- Department of Urology, Broomfield Hospital, Chelmsford, UK
| | - Georgios Tsampoukas
- Department of Urology, Princess Alexandra Hospital Trust, Harlow, UK.,U-merge Ltd.† (Urology for Emerging Countries), London, UK
| | - Elenko Petkov Popov
- U-merge Ltd.† (Urology for Emerging Countries), London, UK.,Department of Urology, University Hospital of Sofia, Sofia, Bulgaria
| | - Zaid Aldin
- Department of Radiology, Princess Alexandra Hospital Trust, Harlow, UK
| | - Mohamad Moussa
- Department of Urology, Al-Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Athanasios Papatsoris
- U-merge Ltd.† (Urology for Emerging Countries), London, UK.,2nd Department of Urology, University Hospital of Athens, Athens, Greece
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Niemczyk G, Zapała Ł, Borkowski T, Szabłoński W, Radziszewski P, Cudnoch-Jędrzejewska A. Feasibility of active surveillance in small testicular mass: a mini review. Cent European J Urol 2021; 74:10-13. [PMID: 33976910 PMCID: PMC8097643 DOI: 10.5173/ceju.2021.0268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/15/2020] [Accepted: 01/07/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Widespread use of scrotal ultrasonography has led to the detection of incidental, non-palpable small testicular masses (STMs). Historically, all intratesticular masses were treated radically, however more conservative strategies are now being applied with growing evidence that up to 80% of STMs are benign lesions. Testis-sparing surgery is deemed a gold standard in STMs. However, the high probability of the benign nature of STMs and the excellent cure rate of localized testicular cancer has led to emerging attempts to use an active surveillance (AS) strategy for selected groups of patients. Material and methods We conducted a non-systematic review of the literature in the PubMed and Embase databases for articles associated with AS strategy in STMs. Results The main inclusion criteria for AS in patients with STMs were lack of risk factors of testicular cancer, no features of disseminated disease, negative tumor markers, non-palpable lesion that did not exceed 10 mm. Mean follow-up time of AS across the studies ranged from 9.6 to 29.6 months. Surveillance protocols were based on regular physical examination, scrotal ultrasonography and measurement of tumor markers. The change rate to active treatment ranged from 0% to 8% without reported deterioration of oncological outcomes. Patients have proceeded to surgical treatment based on their preference, lesion growth, change in echogenicity, tumor marker growth and the need for testicular exploration for other reasons. Conclusions Active surveillance is a reasonable conservative strategy in the management of STMs in selected groups of patients with minimal risk of deteriorating impact on oncological outcomes.
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Affiliation(s)
- Grzegorz Niemczyk
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.,Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Zapała
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Borkowski
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Agnieszka Cudnoch-Jędrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
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Murez T, Fléchon A, Savoie PH, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Méjean A. [French ccAFU guidelines - update 2020-2022: testicular germ cell tumors]. Prog Urol 2020; 30:S280-S313. [PMID: 33349427 DOI: 10.1016/s1166-7087(20)30754-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE - To update French guidelines concerning testicular germ cell cancer. MATERIALS AND METHODS - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated. RESULTS - Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20%. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3 cm. CONCLUSIONS - A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99% in CSI, 85% in CSII+).
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Affiliation(s)
- T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Liu MY, Gray E, Hahn ME, Shiehmorteza M. Scrotal Ultrasound: Updates on Testicular Microlithiasis, Incidental Non-Palpable Lesions, Varicoceles and Testicular Infarction. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lung PFC, Fang C, Jaffer OS, Deganello A, Shah A, Hedayati V, Obaro A, Yusuf GT, Huang DY, Sellars ME, Quinlan DJ, Sidhu PS. Vascularity of Intra-testicular Lesions: Inter-observer Variation in the Assessment of Non-neoplastic Versus Neoplastic Abnormalities After Vascular Enhancement With Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2956-2964. [PMID: 32863063 DOI: 10.1016/j.ultrasmedbio.2020.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/08/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study is to assess the additional benefit of contrast-enhanced ultrasound (CEUS) over conventional ultrasonography (US) in identifying intra-testicular abnormalities among observers of different experiences. In this study, 91 focal testicular lesions (46 neoplastic, 45 non-neoplastic) imaged with gray-scale US/Doppler US and CEUS were classified using a 5-point scale. Three experienced and four inexperienced observers rated each lesion using gray-scale/color Doppler US alone and then with the addition of CEUS. Improved diagnostic specificity and accuracy with the addition of CEUS was observed for both experienced (specificity: 71.1% vs. 59.3%, p = 0.005; accuracy: 83.5% vs. 76.9%, p = 0.003) and inexperienced observers (specificity: 75.6% vs. 51.7%, p = 0.005; accuracy: 80.2% vs. 72.0%, p < 0.001). Significant inter-observer variability between the experienced and inexperienced observers when assessing conventional US alone was eliminated with the addition of CEUS. CEUS improves diagnostic accuracy of focal intra-testicular lesions for both experienced and inexperienced observers and reduces inter-observer variability in inexperienced operators.
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Affiliation(s)
- Phillip F C Lung
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Cheng Fang
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Ounali S Jaffer
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Annamaria Deganello
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Aarti Shah
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Venus Hedayati
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Anu Obaro
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Gibran T Yusuf
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Dean Y Huang
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Maria E Sellars
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Daniel J Quinlan
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom.
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Egan J, Cheaib JG, Biles MJ, Huang MM, Metcalf M, Matoso A, Pierorazio P. Testis-sparing Surgery: A Single Institution Experience. Urology 2020; 147:192-198. [PMID: 33137349 DOI: 10.1016/j.urology.2020.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To demonstrate the safety and efficacy of testis-sparing surgery (TSS) in 2 specific circumstances: small, nonpalpable masses suspected to be benign and masses suspicious for germ cell tumor in a solitary or functionally solitary testicle or bilateral disease. METHODS Our institutional review board-approved testicular cancer registry was reviewed for men who underwent inguinal exploration with intent for TSS (2013-2020). The attempted TSS and completed TSS groups were evaluated for differences using Student's t test for normally-distributed variables, chi-squared and Fisher's exact tests for proportions, and Wilcoxon rank-sum test for nonparametric variables. RESULTS TSS was attempted in 28 patients and completed in 14. TSS was completed only if intraoperative frozen section demonstrated benign disease, except for 1 patient with stage I seminoma and solitary testicle. Sensitivity and specificity of frozen section analysis was 100% and 93%, respectively. There were no significant differences in demographics between attempted vs completed TSS cohorts. Median tumor size was significantly smaller in the completed TSS cohort (1.0 cm vs 1.7 cm, P = .03). In patients with unilateral masses without history of testis cancer, the testis was successfully spared in 9 of 22 cases (41%). In patients with bilateral disease or germ cell tumor in solitary testis, the testis was spared in 5 of 6 cases (83%). At a median follow up of 12.2 months, all patients were alive, and 27 of 28 had no evidence of disease (96%). CONCLUSION TSS is safe and effective for small, benign masses and in the setting of bilateral disease or tumor in a solitary testis.
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Affiliation(s)
- Jillian Egan
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Joseph G Cheaib
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD
| | - Michael J Biles
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD
| | - Mitchell M Huang
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD
| | - Meredith Metcalf
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD
| | - Andres Matoso
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Phillip Pierorazio
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD.
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Organ-Sparing Surgery in Testicular Tumor: Is This the Right Approach for Lesions ≤ 20 mm? J Clin Med 2020; 9:jcm9092911. [PMID: 32917055 PMCID: PMC7565605 DOI: 10.3390/jcm9092911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background: This study was conducted in order to analyze factors predicting malignancy in patients undergoing organ-sparing surgery (OSS) for small testicular lesions. Methods: Patients with small (≤20 mm) marker-negative clinical stage I testicular tumors were managed by OSS with tumor enucleation and frozen section examination (FSE) for the past 15 years at our institution. Benign and malignant cases were compared, focusing on preoperative and postoperative lesion sizes. Results: Eighty-nine patients were enrolled in this retrospective study. Ten (11.2%) of them were treated for synchronous bilateral tumors. Sixty-seven (67.7%) of ninety-nine lesions were benign, confirming a high concordance rate (98%) between FSE and final histology. Patients with benign tumors were significantly older than patients with malignant tumors (p = 0.026), and benign tumors were detected more frequently during urologic work-up of hormone disorders (p = 0.001). Preoperative tumor size was a strong predictor of malignancy (area under the curve (AUC) = 0.726; p < 0.001). According to the Youden index, the best cutoff to predict tumor dignity was 13.5 mm, resulting in a sensitivity and specificity of 53% and 85%, respectively. No cases of local recurrence or distant metastasis were confirmed after a median follow-up of 42 months. Conclusion: Our findings are consistent with previous reports, supporting an OSS approach in small testicular tumors whenever possible. Most tumors ≤ 20 mm were benign, and in the case of malignancy, OSS with FSE and consecutive orchiectomy is oncologically safe due to the high concordance rate of FSE and final histology, thus preventing a two-stage procedure.
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Joshi P, Phillips T. Management of Testicular Torsion and a Contralateral Testicular Mass Presenting Synchronously. Urology 2020; 149:e60-e62. [PMID: 32916189 DOI: 10.1016/j.urology.2020.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
Testicular masses found in prepubertal males are often benign in nature. This has led to an increase in the use of testis-sparing surgery. Testicular torsion is considered a urologic emergency that requires immediate surgical intervention. Based off literature review, it is rare for these unique entities to present synchronously in a single patient. This report demonstrates that in the pediatric population it is possible to safely treat a suspected benign testicular mass with testis sparing mass enucleation if it presents synchronously with testicular torsion in the contralateral testis.
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Affiliation(s)
- Parth Joshi
- Saint Louis University School of Medicine, St. Louis, MO
| | - Timothy Phillips
- Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO.
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Lagabrielle S, Durand X, Droupy S, Izard V, Marcelli F, Huyghe E, Ferriere JM, Ferretti L. Testicular tumours discovered during infertility workup are predominantly benign and could initially be managed by sparing surgery. J Surg Oncol 2018; 118:630-635. [DOI: 10.1002/jso.25203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/24/2018] [Indexed: 11/05/2022]
Affiliation(s)
| | - Xavier Durand
- Urology Department; Val de Grace Hospital; Paris France
| | - Stéphane Droupy
- Urology Department; Carémeau University Hospital; Nîmes France
| | - Vincent Izard
- Urology Department; Kremelin-Bicêtre Hospital; Le Kremlin-Bicêtre France
| | | | - Eric Huyghe
- Urology Department; Rangueil University Hospital; Toulouse France
| | | | - Ludovic Ferretti
- Urology Department; Robert Picqué Hospital; Villenave d’Ornon France
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Rocher L, Feretti L, Camparo P, Savoie PH, Morel-Journel N, Murez T, Sebe P, Flechon A, Méjean A, Durand X. [Non-palpable testicular tumors in adults: A management based on imaging? Issue from the French Urologic Association Genital Cancer committee's edit]. Prog Urol 2018; 28:407-415. [PMID: 29650457 DOI: 10.1016/j.purol.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Help in management of non-palpable testicular tumors. French Urologic Association Genital cancer committee's Edit. OBJECTIVES To review their characterization at imaging findings of non-palpable testicular tumors. DOCUMENTARY SOURCES Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: non-palpable/incidental testicular tumors; color Doppler ultrasound; US elastography; magnetic resonance imaging; contrast enhanced sonography; partial surgery. RESULTS Color Doppler is the basic exam. The size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multiparametric MRI, contrast-enhanced sonography, sonographic elastography are still in evaluation. The frequency of benign tumors such as Leydig cell tumors lead to preservation management, through improved characterization, monitoring or tumorectomy. LIMITS Non-randomized study - a very few prospective studies. CONCLUSION The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on the suspected nature of the tumors.
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Affiliation(s)
- L Rocher
- Service de radiologie diagnostique et interventionnelle, hôpitaux Paris-Sud, site Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté Paris-Sud, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; IR4M, imagerie par résonance magnétique médicale et multi-modalités, CNRS, université Paris-Sud, 91405 Orsay cedex, France.
| | - L Feretti
- Service de chirurgie viscérale et cœlioscopique, hôpital d'Instruction des Armées, 351, route de Toulouse, 33140 Villenave-d'Ornon, France
| | - P Camparo
- Centre de pathologie Amiens-Picardie, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - P H Savoie
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - N Morel-Journel
- Urologie, centre hospitalier Lyon-Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - T Murez
- Service d'urologie et de transplantation rénale, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - P Sebe
- Groupe hospitalier Diaconesses-Croix-Saint-Simon, 75012 Paris, France
| | - A Flechon
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - A Méjean
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - X Durand
- Hôpital IA Begin/Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris, France
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Esen B, Yaman MÖ, Baltacı S. Should we rely on Doppler ultrasound for evaluation of testicular solid lesions? World J Urol 2018; 36:1263-1266. [PMID: 29572727 DOI: 10.1007/s00345-018-2273-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/16/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Colour Doppler ultrasound (CDUS) is the main radiologic tool to evaluate scrotal masses and intratesticular-vascularised solid lesions are mostly considered malign lesions. Objective of this trial is determine ratio of benign lesions in patients with hypervascularised solid intratesticular lesions. MATERIAL AND METHOD Patients who underwent radical orchiectomy due to hypervascularised intratesticular solid lesions detected in CDUS are evaluated retrospectively. Those with previous testicular cancer history and inguinal/scrotal surgeries were excluded from the study. All patients are evaluated for age, preoperative testicular atrophy, multicentricity, echotexture and size of solid lesions, preoperative tumor markers (AFP, bHCG and LDH), and postoperative pathology results. Two tailed p value test was used to evaluate numeric parameters and Fisher's exact test was used to evaluate non-numeric parameters. RESULTS A total of 117 patients with a mean age of 35.9 (5-86) were included to the study. Mean size of solid lesions was 4.39 cm. Seven patients had subcentimeter (subcm) lesions. 101 patients had hypoechoic, ten patients had isoechoic and six patients hyperechoic solid lesions. Preoperatively 60 patients (51.2%) had at least one tumor marker elevated. Postoperative pathology examination resulted to; 21 patients (17.9%) had benign lesions. Elevation of tumor markers, palpability, hypoechoic texture and larger size of the solid lesion were found to be parameters that predict malignancy. CONCLUSION Benign incidence of vascular testicular solid lesions detected with scrotal ultrasound with colour Doppler is greater than expected. In patients with smaller, non-palpable lesions without elevated tumor markers, treatment options other than radical orchiectomy such as testicular sparing surgery should be considered.
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Affiliation(s)
- Baris Esen
- Department of Urology, Medical Faculty, Ankara University, Ankara, Turkey.
| | | | - Sümer Baltacı
- Department of Urology, Medical Faculty, Ankara University, Ankara, Turkey
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Paffenholz P, Held L, Loosen SH, Pfister D, Heidenreich A. Testis Sparing Surgery for Benign Testicular Masses: Diagnostics and Therapeutic Approaches. J Urol 2018. [PMID: 29530784 DOI: 10.1016/j.juro.2018.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Small benign testicular masses are often misinterpreted as germ cell tumors and immediate inguinal orchiectomy is performed. We analyzed the diagnostic and therapeutic workup of testicular masses to improve preoperative stratification algorithms. MATERIALS AND METHODS We performed a retrospective, single center analysis of the records of 522 patients diagnosed with primary testicular masses of unknown malignant potential. RESULTS A total of 28 patients (5%) showed a primary benign tumor after resection, including Leydig cell tumors in 9 (32%), epidermoid cysts in 9 (32%), adenomatoid tumors in 8 (29%) and Sertoli cell tumors in 2 (7%). The median volume of benign tumors was significantly less than that of malignant tumors (0.75 cm3, range 0.1 to 2.1 vs 15, range 4.5-39.9, p ≤0.001). At a cutoff of 2.8 cm3 tumor volume most accurately differentiated between benign and malignant disease, and it was a predictor of malignancy with 83% sensitivity and 89% specificity (OR 1.389, 95% CI 1.035-1.864, p = 0.029). Symptom duration in patients with benign tumors was significantly longer (365 days, range 25.5 to 365 vs 20, range 7 to 42, p ≤0.001). Also, tumor markers were unaltered in benign lesions. In patients with benign tumors significantly more fertility disorders or cryptorchidism were found (p ≤0.001) as well as a tendency toward lower testosterone (3.9 μg/l, range 0.9 to 4.9 vs 5.3, range 3.5 to 6.8, p = 0.084). Testis sparing surgery was performed in 22 of all patients (79%) with benign tumors. There was no case of relapse during followup. CONCLUSIONS Nongerm cell tumors should be considered when small testicular masses have a volume of less than 2.8 cm3 and there are hormone disorders or normal tumor markers. Immediate orchiectomy should be avoided, favoring testis sparing surgery.
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Affiliation(s)
- Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany
| | - Linn Held
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany
| | - Sven H Loosen
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany.
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Smith JA. This Month in Adult Urology. J Urol 2018. [DOI: 10.1016/j.juro.2017.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hanson BM, Eisenberg ML, Hotaling JM. Male infertility: a biomarker of individual and familial cancer risk. Fertil Steril 2018; 109:6-19. [DOI: 10.1016/j.fertnstert.2017.11.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/15/2017] [Accepted: 11/07/2017] [Indexed: 12/13/2022]
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